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Resistance Training To Counteract the Catabolism of a Low-Protein Diet in Patients with Chronic Renal Insufficiency: A Randomized, Controlled Trial

Carmen Castaneda, MD, PhD; Patricia L. Gordon, RN, PhD; Katherine Leigh Uhlin, RD, MS; Andrew S. Levey, MD; Joseph J. Kehayias, PhD; Johanna T. Dwyer, DSc, RD; Roger A. Fielding, PhD; Ronenn Roubenoff, MD, MHS; and Maria Fiatarone Singh, MD
[+] Article and Author Information

From Tufts University, New England Medical Center, and Boston University Sargent College of Health and Rehabilitation Sciences, Boston, Massachusetts; and University of Sidney, Lidcome, Australia.


Disclaimer: Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the U.S. Department of Agriculture.

Acknowledgments: The authors thank the volunteers, who made this study possible, for their kind and valuable cooperation. They also thank the recruitment, nursing, and dietetic staff of the Metabolic Research Unit for their help in undertaking this study; the Nutrition Evaluation and Mass Spectrometry Laboratories at the HNRCA for their valuable assistance with biochemical and isotopic analyses; Keiser Sports Health Equipment, Inc., for the donation of the resistance training equipment; and Woodway USA for the donation of the treadmill. They especially thank the late Nancy Lundgren, MS, for her valuable help in the isotopic analyses. Finally, they thank Drs. James Strom and Geetha Narayan, Saint Elizabeth's Hospital; Dr. Henry Yager, Newton Wellesley Hospital; Drs. Elizabeth Bouthot, Chrisopher Ying, Mark Parker, and Samir Kassissieh, Lahey Hitchcock Clinic; and Drs. John T. Harrington, Nicolaos E. Madias, Klemens B. Meyer, Ronald D. Perrone, Andrew J. King, and Mark Sarnak, the attending physicians of the Nephrology Clinic at New England Medical Center.

Grant Support: In part by the National Institute on Aging (RO1 AG13457), the New England Medical Center Research Fund, and the U.S. Department of Agriculture, Agricultural Research Service (58-1950-9-001).

Requests for Single Reprints: Carmen Castaneda, MD, PhD, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111; e-mail, ccastaneda@hnrc.tufts.edu.

Current Author Addresses: Drs. Castaneda, Gordon, Kehayias, and Roubenoff: Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111.

Ms. Uhlin and Dr. Levey: Division of Nephrology, New England Medical Center, 35 Kneeland Street, Boston, MA 02111.

Dr. Dwyer: Frances Stern Nutrition Center, New England Medical Center, 750 Washington Street, Boston, MA 02111.

Dr. Fielding: Department of Health Sciences, Boston University Sargent College of Health and Rehabilitation Sciences, 635 Commonwealth Avenue, Boston, MA 02215.

Dr. Singh: School of Exercise and Sport Science, Faculty of Health Sciences, University of Sidney, East Street, Lidcombe 2141 NSW, Australia.

Author Contributions: Conception and design: C. Castaneda, A.S. Levey, J.T. Dwyer, R.A. Fielding, M.F. Singh.

Analysis and interpretation of the data: C. Castaneda, A.S. Levey, J.J. Kehayias, J.T. Dwyer, R. Roubenoff, M.F. Singh.

Drafting of the article: C. Castaneda, A.S. Levey, J.J. Kehayias, J.T. Dwyer, R. Roubenoff, M.F. Singh.

Critical revision of the article for important intellectual content: C. Castaneda, A.S. Levey, J.T. Dwyer, R. Roubenoff, M.F. Singh.

Final approval of the article: C. Castaneda, P.L. Gordon, K.L. Uhlin, A.S. Levey, J.J. Kehayias, J.T. Dwyer, R.A. Fielding, R. Roubenoff, M.F. Singh.

Provision of study materials or patients: C. Castaneda, A.S. Levey.

Statistical expertise: M.F. Singh.

Obtaining of funding: C. Castaneda, A.S. Levey, R.A. Fielding, M.F. Singh.

Administrative, technical, or logistic support: C. Castaneda, P.L. Gordon, K.L. Uhlin, J.T. Dwyer, R. Roubenoff, M.F. Singh.

Collection and assembly of data: C. Castaneda, P.L. Gordon, K.L. Uhlin, J.J. Kehayias.


Ann Intern Med. 2001;135(11):965-976. doi:10.7326/0003-4819-135-11-200112040-00008
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Chronic renal insufficiency, regardless of cause, generally progresses to end-stage renal disease (1). Malnutrition and muscle wasting in chronic uremia often parallel the progression of renal failure (2). They also contribute to excess morbidity and mortality in patients with renal disease (3). Protein-restricted diets delay the progression of renal disease (45) and alleviate uremic symptoms (6). Although nutritional status, as assessed by biochemical and anthropometric indicators, may be maintained during protein restriction (67), studies have shown that deterioration of nutritional status is associated with low energy and protein intake in patients with chronic renal insufficiency (8).

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Figures

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Figure 1.
Flow of patients through the study.

* The post office returned letters because addresses were incorrect or persons had relocated. † No patients withdrew, experienced ineffective interventions, or were lost to follow-up. One patient in each group had incomplete postintervention measures because of health-related reasons. HNRCA = Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging.

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Figure 2.
Univariate linear association between the absolute change in total body potassium and the percentage change in muscle strength for each patient following the low-protein diet plus resistance training (squares) or the low-protein diet alone (circles).

r = 0.36; P < 0.05. The solid line indicates linear regression.

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Figure 3.
Univariate linear association between postintervention total body potassium and postintervention serum albumin concentrations for each patient following the low-protein diet plus resistance training (squares) or the low-protein diet alone (circles).

r = 0.52; P = 0.01. The solid line indicates quadratic regression.

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Summary for Patients

Weight-Training Exercises To Counteract the Negative Effects of Low-Protein Diets in People with Kidney Disease

The summary below is from the full report titled “Resistance Training To Counteract the Catabolism of a Low-Protein Diet in Patients with Chronic Renal Insufficiency.” It is in the 4 December 2001 issue of Annals of Internal Medicine (volume 135, pages 965-976). The authors are C Castaneda, PL Gordon, KL Uhlin, AS Levey, JJ Kehayias, JT Dwyer, RA Fielding, R Roubenoff, and MF Singh.

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